Is telehealth dead in Australia?

The recent MYEFO Budget Update released on October 22 2013 has added further restrictions to the telehealth consultations announced by the prime minister in the lead up to the last election, and eventually made available on July 1 2011. From January 1 2013 new geographic restrictions have been added to those introduced in the May budget basically making telehealth consultations available only to those who live in remote areas. Those in outer metropolitan areas and major cities of Australia as defined by the Australian Standard Geographical Classification Remoteness Areas (ASGC-RA) will miss out.

In my opinion this is the beginning of the end of telehealth consultations in Australia. By marginalising them to only a delivery method suitable for remote populations, essentially a technology enabled version of the Royal Flying Doctor Service, they are significantly blunting the value proposition for telehealth consultations. Actually they are restricting it more than the RFDS, as it can deliver services to places not limited to those classified as remote, but to those areas that need its help. Essentially these changes have taken away from clinicians the right to make that type of decision. Rather than expand on what seems to have been a successful program, it has chosen to “strangle it on the vine” to prevent its growth.

Telehealth consultations have the possibility of radically improving the efficiency and effectiveness of healthcare delivery for all Australians by allowing clinicians to provide a more cost effective, and better targeted service to those who need it. It is not just about extending specialist care to those in remote areas. Whilst that is part of it, the problem is that by marginalising it to such a small part of the population they effectively strangle its growth. As a result less clinicians will try it and make it part of their normal repertoire. It will not become a tool that many clinicians will use, and those that do will be stifled by the extra paper work associated with delivering it, and the fear of an audit which shows that a patient lived 1 km outside the boundaries of remote Australia, and therefore was not eligible.

The bright hope of the telehealth announcements and subsequent actions by the government was that technology would be seen as an enabler of health reform. The concept of delivering care is the most efficient and effective way that is suitable for an individual patient seemed to be becoming a reality. Telehealth had the possibility of not just delivering care to remote Australia, but to many areas of need, with short supply of healthcare providers of many different types. More exciting was the prospect that clinicians could develop new and innovative models of care for people with chronic disease, which now includes diseases like cancer and auto immune diseases as well as the well known ones of diabetes, heart and lung disorders and others. These are the major burden on the Australian health system, and the inefficiency in their management has led to them becoming a major cost burden on the healthcare system. By innovating in new models of care that could leverage technology such as video conferencing to make that care not just cheaper, but as evidenced in many trials also better, there was an opportunity for Australia to become a world leader.

However, in an attempt to save $130 million over 4 years the government has lost an opportunity to potentially save billions from the annual healthcare expenditure, which is at $130 billion now, and predicted to continue rising. I remain slightly confused how that money will be saved. The individual still has the right to receive the same level of care,   they just have to work out how to get to the specialist’a rooms in the city. The hidden costs associated with that still need to be paid for.

At a time when we are investing, in my belief wisely, some $40 billion to deliver a National Broadband Network, we have essentially cut off one of its best business cases, telehealth consultations, to save a relatively small amount. To a rational investor this would seem bizarre. To a nation that prides itself on being a world leader in healthcare and innovation it is essentially the kiss of death to an opportunity which had not only great local value, but also potentially an opportunity for Australia to become the telehealth hub of the Asia-Pacific region, and possible even beyond.

15 Responses to “Is telehealth dead in Australia?”

  1. Greg Mundy Says:

    It’s a setback no doubt about it. The in strategic nature of it is a more profound concern if it means that the Goverment has lost the plot on this I hope they spend the savings wisely.

  2. James Billington Says:

    Note dead George, but in an induced coma. This politically expedient decision for short term budget savings exposed the Governments lack of political will. I also share Greg’s concern that the Government has lost the plot.One wonders if those responsible for this decision comprehend any of the points on your blog.

  3. Amedar Says:

    Amedar…

    You could certainly see your enthusiasm within the work you write. The sector hopes for more passionate writers like you who are not afraid to mention how they believe. Always follow your heart. “He never is alone that is accompanied with noble though…

  4. Andrew Williams (@42kninja) Says:

    In spite of this set back I believe will telehealth will continually grow. Albeit more slowly than is needed. I have first hand experience of sourcing, planning and implementing a telehealth model of care that is improving clinical workflows and saving lives. The public will demand even if politicians remain too short sighted to its benefits. Keep the faith gentlemen!

    • James Billington Says:

      Hi Andrew,
      We recently collaborated on a Teleheath Network installation with a new Super GP Clinic and two Medical practices.Now they are ready to Network with two nursing homes & private patients. However due to the Govt’s closure on rebates for Telehealth consultations from Jan 1st 2013 I’ve had a request for examples of e-Health payment models to help pay for “all this equipment”
      Your input would very appreciated.
      Regards,
      James

  5. Leif Hanlen Says:

    I largely agree George, but I would say not yet dead – desperate, but not yet terminal. http://leifhanlen.wordpress.com/2012/10/31/a-guaranteed-budget-surplus-at-what-cost-to-telehealth/

  6. Clare Ward Says:

    It appears the voracious appetite for surplus and the adulation that would follow is overriding the necessary investment and political will to do good beyond ones term of office! If only vision were more a part of our political landscape we would not need your blog to play devils advocate when we err… but then we’d be missing out too! It’s a toss up George! Intellectual gymnastics v’s Politicians with backbone?

  7. Michael Gill Says:

    Thank you George for your thoughts and efforts re Telehealth. While I agree that the government is being short sighted I am not convinced that we have lost $130 million over four years. Buckets of money have a habit of disappearing and reappearing.

    Telehealth is not about geography but is about access. You are spot on. I would go one step further and say the real opportunity for telehealth is to break down the silos of community care, primary care, specialists and acute.

    The time for telehealth experimentation is and should be over. We need large scale projects not a series of pilots. We need to move away from the technology debate and focus instead on clinicial work flow innovation and the business model of service delivery. I doubt very much that there is a a sustainable ROI for a single service telehealth instance. What is needed is a focus on specific clinical areas (as you suggest) but also a clustering of carefully selected complimentary services.

    Mike Gill
    Former HISA Telehealth Conference Chair.

    • georgemargelis Says:

      Thank you Mike.
      My concern is that in fact the $130 million will not be saved, just shifted from telehealth MBS items to non telehealth MBS items and associated costs required to get those people to their physical consultations. Even worse to cover the costs associated with managing the complications as a result of not getting timely access to the required specialist care.
      Telehealth is being marginalised as an orphan technology rather than an acceptable delivery model. The fact that it can be scaled up and down to meet non clinical criteria is concerning. We don’t tell doctors to stop using their stethoscope to meet budgetary restrictions, why do we tell them to stop using telehealth to deliver a service and consider that acceptable?

  8. Dr. ASP Hua, Consultant geriatrician, Melbourne Says:

    If the specialist is more than 15 km away, but the patient and his GP are within the metropolitan area and not in a nursing home or aboriginal or Torres Strait islander, can Medicare rebate the Telehealth consultation after Jan 1 2013? I know how hard it is to find geriatricians who are willing to physically travel across town to see patients.

    • georgemargelis Says:

      From my understanding of the new rules patients in metropolitan areas who are not in a residential care facility or AMS will NOT be eligible for reimbursement for telehealth consultations with a specialist. So either the patient will need to make their way to the doctor, or the doctor to them. The third option is to wait till you are sick enough to need an ambulance to take them to the local public hospital, and the specialist will be able to admit them and see them there. Not sure that is the best option for the patient, doctor or healthcare system.

  9. Dr. ASP Hua, Consultant geriatrician, Melbourne Says:

    This is quite contrary to the Commonwealth policy of encouraging the elderly to remain in the community with additional support. If an elderly person receives an EACH package to remain at home but his home is within the RA-1 (metropolitan) zone, and he needs the services of a geriatrician, but cannot find one who will visit him at home (a very likely scenario), then this new policy is discriminatory in favour of those frail elderly who cost the government a lot more money by moving into an aged care facility.

    • georgemargelis Says:

      Spot on Dr Hua.It is a particularly short sighted policy which disadvantages the bulk of the aged population but also forces solution providers to try and develop their products into environments that lack the required connectivity thus forcing them to fail. Bizarre policy making in isolation of reality and any clinical input.

  10. Greg Mundy Says:

    Is the Govt planning to use ASGC-RA to determine eligibility does anyone know? If they do then Hobart (all Tas) and Darwin may both qualify…

  11. Telehealth and the MBS | eHealth Enthusiast Says:

    [...] Some claw back has occurred since the creation of the provision but it is nonetheless progress. Commentators state that this statistical exclusion criteria are enough to prevent any mainstream adoption of [...]

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